Centers for Independent Living in the Changing Institutional Transition and Diversion Marketplace: Key Findings Report

On November 28, 2016, regulations went into effect implementing new core services in Centers for Independent Living (CILs) that 1) facilitate the transition of individuals with significant disabilities from nursing homes and other institutions to home and community-based residences, with requisite supports and services; 2) provide assistance to individuals who are at risk of entering institutions so that the individuals remain in the community; and 3) facilitate the transition of youth who are individuals with significant disabilities, who were eligible for individualized education programs (IEPs) under Section 614(d) of the Individuals with Disabilities Education Act, and who have completed their secondary education or otherwise left school to post-secondary life.

The shift in funding landscape for institutional transition and diversion services occurred quickly, particularly the growth of Medicaid managed long-term services and supports (MTLSS) and the number of MCOs contracting with states. There are more than 380 CILs across the nation that receive federal funding. It is unclear how CILs have adapted to these funding changes including how they see themselves in this new marketplace, what challenges they face in doing transition and diversion work, how they are funding this work, and what type of training and technical assistance needs are required to help them succeed in a more business-oriented model of service provision.

To answer these questions, informational interviews were conducted with a subset of CILs identified as having a net operating budget above one million dollars in 2014. The ILRU survey team believed CILs above this threshold are likely generating income through sources other than grant funding – and therefore the most likely to contract with states’ Medicaid programs or with MCOs in their states. The aim of the survey was for the identified CILs to better explain how Centers in general are negotiating institutional transition and diversion work in the changing marketplace.

All of the interviews were recorded, transcribed, and coded with a content analysis approach aimed at identifying similar experiences and practices as well as those that differed. The information was categorized and compiled to report key findings. From the key findings, promising practices and areas for technical assistance were extracted. In the appendices, selected stories of successful institutional transitions and diversions, in addition to unsuccessful institutional transitions are provided as context to these key findings.

This project compiles information on institutional transition and diversion practices targeted towards adults from conversations with CILs. The project is not a research study to investigate and analyze these practices scientifically. Although the survey team stands behind the approach to information gathering and synthesis, it cannot be determined that findings reflect the entire range of experiences and knowledge of either the invited CILs or all CILs nationally. The discussions with CILs were candid. As such, the report contains aggregated information and does not quote or identify individual CIL responses or practices.